elft quality improvement roadshow - 2014
DESCRIPTION
Slides from the East London NHS Foundation Trust roadshow on quality improvementTRANSCRIPT
Quality Improvement Roadshow
Roadshow Video
Our quality improvement programme
Why?
The strategic case for change
Changing the culture through quality improvement
Involvement of service users and carers through every step of the journey
The culture we want to nurture
Our quality improvement programme
How?
Long-term mission and stretch aims
The mission
To provide the highest quality mental health
and community care in England
by 2020
Quality improvement strategy
Reduce harm by 30% every year
Right care, right place, right time
Two stretch aims
Long-term mission and stretch aims
How many incidents of harm were reported in 2013?
How much harm currently occurs in our care?
1. Under 100 6. 2000 – 30002. 100 – 250 7. 3000 – 40003. 250 – 500 8. 4000 – 50004. 500 – 1000 9. 5000 – 60005. 1000 - 2000 10. 6000 - 7000
How many incidents of harm were reported in 2013?
How much harm currently occurs in our care?
1. Under 100 6. 2000 – 30002. 100 – 250 7. 3000 – 40003. 250 – 500 8. 4000 – 50004. 500 – 1000 9. 5000 – 60005. 1000 - 2000 10. 6000 - 7000
Answer = 2881
Long-term mission and stretch aims
What proportion of our patients currently state they are extremely likely to recommend our services to their friends and family?
Patient experience?
1. Under 10%2. 10 – 20%3. 20 – 40%4. 40 – 60%5. 60 – 80%6. 80 – 100%
What proportion of our patients currently state they are extremely likely to recommend our services to their friends and family?
Patient experience?
1. Under 10%2. 10 – 20%3. 20 – 40%4. 40 – 60%5. 60 – 80%6. 80 – 100%
Long-term mission and stretch aims
Central QI team
Functions
Coordinate the programme
Improvement expertise to support frontline work
Learning and sharing – internally & externally
Make-up
Programme director (Medical Director)
Deputy programme director (Associate Medical Director)
Programme manager
Continuous improvement and measurement lead
2 x rotating clinical secondments
Programme support
Central QI team
Building the will
Long-term mission and stretch aims
Traditional engagement
Grassroots movement /
campaign
• Launch event & roadshows• Through formal directorate structures• Local champions
• Q30 (staff) and Q12 (service user) groups to shape our comms• Microsite – as a central resource• Branding & identity
Central QI team
Building the will
Long-term mission and stretch aims
Aligning our systems
Clinical auditReal-time patient experience feedbackLearning from
complaints
Datix improvements
Reviewing our inductions Integrated quality data
available to all
Embedding a structure for listening
Outcome measures
Influencing contracts and CQUINs
Financial measures
Stopping activity of lower value
Central QI team
Building the will
Long-term mission and stretch aims
Aligning our systems
Building improvement skills
Successful improvement
requires a specific set of skills
Most of us have not been trained in improvement
Improvement at scale needs a
consistent approach
Appointment of an external partner to build skills within our workforce at scale & pace
Methodology
How do we deliver a consistent approach to quality?
Introduction to our external partner
Independent, not-for-profit organisation
Based in Cambridge, Massachusetts
Leading innovator, convenor, partner and driver of results in health and healthcare worldwide
5 key areas of work
• Improvement capability• Patient and family-centred care• Patient safety• Quality, cost and value• Triple aim for populations (improving health
outcomes, experience and per capita cost)
A P
DS
Plan
DoStudy
Act
AIM: What are we trying to accomplish?
MEASURES: How will we know if achange is an improvement?
CHANGE: What changes can we makethat will result in improvement?
The Model for Improvement
Plan• Objective• Questions &
predictions• Plan to carry out:
Who?When?How? Where?
Do• Carry out plan• Document
problems• Begin data
analysis
Act• Ready to
implement?• Try something
else?• Next cycle
Study• Complete data
analysis• Compare to
predictions• Summarize
“What will happen if we try something different?”
“Let’s try it!”“Did it work?”
“What’s next? ”
The PDSA Cycle
Spread to other sites / groups / popn
Develop a change
Implement a change
Test a changeTheory and Prediction
Test under a variety of conditions
Make part of routine operations
`
A P
DS
The Steps to Change
Measurement and Using Data for Improvement
How Do ELFT Use Measurement?
MMSE
CQUINS & KPIs
Clinical Trials and Research
Service user outcomes
Service user experience
Waiting lists
BPRS
Blood results
• Research (efficacy)
• Improvement (efficiency and effectiveness)
• Accountability (reassurance, comparison)
The Three Faces of Measurement
ResearchAim New Knowledge (efficacy)
Methods:Test observability
Tests are blinded or controlled
Bias Designed to eliminate bias
Sample size ‘Just in case data’ (very large data sets)
Flexibility of hypothesis
Fixed hypothesis
Testing Strategy One large test
Determining if a change is an improvement
Enumerative Statistics (t-test, p-values)
ImprovementAim Improvement of care
(efficiency and effectiveness)
Methods:Test observability
Tests are observable
Bias Accept consistent bias
Sample size ‘Just enough data’, small sequential samples
Flexibility of hypothesis
Flexible and changes as learning takes place
Testing Strategy Sequential test over time
Determining if a change is an improvement
Analytical statistics. Run and Control charts
AccountabilityAim Comparison, choice,
reassurance, motivation for change
Methods:Test observability
No test, evaluate current performance
Bias Measure and adjust to reduce bias
Sample size Obtain 100% of available, relevant data
Flexibility of hypothesis
No hypothesis
Testing Strategy No tests
Determining if a change is an improvement
No change focus
• Research (efficacy)
• Improvement (efficiency and effectiveness)
• Accountability (reassurance, comparison)
The Three Faces of Measurement
Does this represent improvement?
1.Yes 2. No
• How can you tell if you are improving?
• Data collection and analysis are central to QI• Helps identify quality problems but also opportunities
for improvement• Allows us to track improvement over time• Success of programme will hinge on the
measurements we put in place
Why Measure?
Training Plan for the Organisation
• IHI Open School programme available to all staff
• Face to face training for 200 staff in next year
• Learning Events (Autumn 2014)
Training Plan for the Organisation
“I’m In” Video
Break
Starting an Improvement Project
qi.eastlondon.nhs.uk
Key Ingredients for Success
And why is this important?(the strategic and business case)
What are We Trying to Accomplish?
• Involve members familiar with all different parts of the process
• Effective teams require three kinds of expertise– System leadership– Improvement advice– Day to day leadership - Project leader
• Aim to meet every 1-2 weeks for 30-45 minutes• How will you communicate?• How to bring data to meeting?
Choose your team
The Driver Diagram is a tool to help us understand the system, its outcomes and the processes that drive the outcomes
Defining your messy system
AIM
Primary driver
Primary driver
Secondary driver
Secondary driver
Secondary driver
Secondary driver
Secondary driver
Change 1
Change 2
Change 3
AIM:Lose 5kg
in 3 months
Calories in
Calories out
Limit daily intake
Substitute low calorie
food
Avoid alcohol
Exercise
Fidgeting
Track calories
Plan meals
Drink water, not Coke
Work out 3 times a week
Cycle to work
Hacky sack in office
AIM PRIMARY DRIVERS SECONDARY DRIVERS
CHANGE IDEAS
Improving quality of care on an inpatient female psychiatric ward
Draw a Driver Diagram
A P
DS
Plan
DoStudy
Act
AIM: What are we trying to accomplish?
MEASURES: How will we know if achange is an improvement?
CHANGE: What changes can we makethat will result in improvement?
The Model for Improvement
Video: Overview of the model for improvement
• A strong, measurable aim with a clear time frame will help keep your project on course
• It has to be important to those involved A P
DS
Plan
DoStudy
Act
AIM: What are we trying to accomplish?
MEASURES: How will we know if achange is an improvement?
CHANGE: What changes can we makethat will result in improvement?
The Aim
• Be creative
A P
DS
Plan
DoStudy
Act
AIM: What are we trying to accomplish?
MEASURES: How will we know if achange is an improvement?
CHANGE: What changes can we makethat will result in improvement?
Developing Changes
• Measurement is critical for testing and implementing changes
• Different from measurement for research A P
DS
Plan
DoStudy
Act
AIM: What are we trying to accomplish?
MEASURES: How will we know if achange is an improvement?
CHANGE: What changes can we makethat will result in improvement?
Measurement
Video: The Model for Improvement, Developing Changes and Measurement
The PDSA Cycle
Plan• Objective• Questions &
predictions• Plan to carry out:
Who?When?How? Where?
Do• Carry out plan• Document
problems• Begin data
analysis
Act• Ready to
implement?• Try something
else?• Next cycle
Study• Complete data
analysis• Compare to
predictions• Summarize
“What will happen if we try something different?”
“Let’s try it!”“Did it work?”
“What’s next? ”
Video: The PDSA Cycle
Complete Project Charter
• Email to QI team • [email protected]• QI team will get in contact in a few days
• Make sure you have right ingredients for success• Help finalise charter• Make sure your project aligns with programme
aims• Link you with support on project and
methodology• Provide support and access to BMJ Quality
platform
The QI Team Will…
Draft Measurement Framework
Mission and AimsMission: Highest Quality Mental Health and Community Care in England
Stretch Aim 1: Right care, Right Time
Stretch Aim 2: Reduce Harm
Improved Patient Experience
Summary and Close